Anxiety, Obsessive-Compulsive, & Trauma-and Stressor-Related Disorders

These flashcards cover key vocabulary and concepts related to anxiety disorders, their classifications, symptoms, treatments, and theoretical perspectives.

Anxiety Disorders

Characterized by feelings of excessive fear and anxiety, and related behavioral disturbances.

●Avoidance of objects or situations is a key issue

 

●they can often be out of touch with reality

 

●based on an individual’s perceptions and can therefore be out of proportion to actual environmental threats

 

Psychopathology

refers to problematic patterns of

thought, feeling or behaviour that disrupt an individual's sense of wellbeing or social or occupational functioning.

 

Psychopathology And culture

Many forms of psychopathology are found across cultures;

however, cultures differ in the disorders to which their members are vulnerable and the ways they categorise mental illness.

One view sees mental illness as a myth used to make people conform to society's standards of normality;

labelling theory similarly argues that diagnosis is a way of stigmatising deviants.

Both approaches have some validity but understate the realities of mental illness.

Generalized Anxiety Disorder (GAD)

Most common type of anxiety disorder, classified as excessive anxiety and worry about multiple events or activities for at least 6 months.

●involves perseverative (or stubborn), negative thinking about things that can go wrong

 

●additional symptoms such as restlessness, difficulty concentrating, muscle tension, irritability, increased heart rate

 

●Significantly impacts a person’s daily life

 

Panic Disorder

Characterized by one symptom, the panic attack, an abrupt surge of intense fear or discomfort.

• The attack of intense fear and feelings of doom or terror not justified for the situation

 

Panic = abrupt surge of intense fear or intense discomfort that reaches a peak within minutes

 

include many physiological symptoms: 

• heart palpitations 

• trembling or shaking

• feeling of choking

• nausea/dizziness or abdominal 

• chills or heat sensations

• intense fear of losing control or fear of dying

 

 

●Single panic attack does not qualify as disorder

 

●Can lead to avoidance of prior symptoms or scenarios of prior attacks

• E.g., avoiding buses if prior attack there

• In prone panic individuals, fear of their own autonomic responses magnifies anxiety may trigger future attack

 

●Can lead to agoraphobia – fear of places where escape seems hard

 

Agoraphobia

• Definition: fear of being in places from which escape seems difficult or where help might not be available in the event of embarrassing or incapacitating symptoms.

 

• Relationship to panic: people who experience random panic attacks may fear attending social events and leaving the house due to the risk of an attack.

Specific Phobias

Irrational and persistent fear caused by the thought of a provoking object, animal, or situation.

●Irrational and persistent fear caused by the thought of provoking object, animal, or situation

 

●Debilitating when phobia is triggered 

 

●must be life affecting to be considered as part of a disorder

 

●Avoidance of situations that can trigger the phobia is paramount of the person with the specific phobia

Agoraphobia

Fear of being in places from which escape seems difficult or where help might not be available.

TREATMENTS FOR SPECIFIC PHOBIAS

●Most common treatment is exposure therapy

 

●Client is exposed gradually to the thing that they are afraid of

 

●Includes the use of Virtual Reality 

 

●Next stage combines virtual reality with physical sensations (e.g., fake spider)

 

●Next stage place it somewhere the person is likely to see it

 

●Different to flooding where client is exposed to object in one dramatic burst as it’s thought that anxiety has a peak and will eventually decrease

 

●Gradual exposure is more effective than flooding

SOCIAL ANXIETY DISORDER

Common type of phobia is social anxiety disorder

 

excessive fear or anxiety about social situations in which the individual is exposed to possible scrutiny.

 

●fear of being judged, of being evaluated negatively. 

 

●frequently concerned about others noticing their anxiety symptoms 

 

●Leads to avoidance of situations or social events

Obsessive-Compulsive Disorder (OCD)

Involves obsessions (intrusive thoughts) and compulsions (behavioral responses) that cause significant distress.

●Obsessions

are intrusive, irrational thoughts, or ideas such as notion that a terrible accident is about to occur to a loved one

Can include :

repetitive thoughts of contamination, 

•self-doubt and having difficulty tolerating uncertainty

•Needing things orderly and symmetrical

•Unwanted thoughts, including aggression , like hurting other people

●Compulsions

 intentional behaviours or mental acts performed in response to an obsession

• to reduce the anxiety provoked by the obsession

• Performance of ritual

• Prevention of performing ritual they are likely to experience intense anxiety or panic attac

●If compulsions are blocked intense anxiety or panic attack is experienced

Common compulsions are: 

•counting 

•excessive handwashing 

•arranging and re-arranging

•repeatedly checking doors or appliances

•avoiding objects due to superstition

•hoarding

Post-Traumatic Stress Disorder (PTSD)

Persistent re-experience of traumatic events, leading to distressing recollections, dreams, or flashbacks.

●Classified as Trauma- and Stressor-Related Disorders in the DSM-5-TR

 ●Persistent re-experience of traumatic events

 ●Distressing recollections, dreams, hallucination, or flashbacks

 ●Thoughts are often uncontrollable and are likely to be accompanied by nightmares

 ●Actively avoid things that trigger memories of their trauma

 ●Experience emotional numbing where they don’t feel emotions as strongly as prior to trauma

 ●Show hyper-vigilance (constantly scanning the environment)and heightened arousal 

 ●Can occur if they’ve experienced or witnessed a violent event

• can last lifetime

• Personality coping styles intellectual functioning can predispose people through anxiety disorders as well as PTSD

Diathesis-Stress Model

A theory that explains the interaction between genetic predispositions and environmental stressors in developing anxiety disorders.

●Addresses the combination of genetic predisposition and stressful environments

●genetic factors can place an individual at risk of developing an anxiety disorder BUT

●environmental stress factors must impinge for the potential risk to manifest itself

 Genetics contribute to anxiety symptoms, but the interaction between genetics and stressful environmental influences accounts for more anxiety disorders than genetics alone.

• Diathesis-Stress Hypothesis: genetic factors can place an individual at risk (diathesis), but environmental stress factors must impinge in order for the potential risk to manifest as an anxiety disorder.

• Essentially: even with genetic predisposition, a very stressful environment is often required to trigger an anxiety disorder.

• This model links biology with environment and helps explain why not all genetically at-risk individuals develop disorders.

AETIOLOGY/ CAUSE OF ANXIETY AND RELATED DISORDERS

Biological factors:

●Biological preparedness which is the predisposition to being afraid of things that can cause us harm.

Neurochemical factors:

●Low levels of GABA or serotonin may also have increased anxiety 

Genetic basis:

●Monozygotic twins – if one twin has anxiety there is a 35% chance that the other twin will too

●Dizygotic twins - 15% chance that the other twin will also have an anxiety disorder

●Moderate genetic predisposition towards anxiety

 

 

Cognitive Behavioral Therapy (CBT)

A therapeutic approach to manage thoughts and behaviors related to anxiety and obsessive-compulsive disorders.

Biological Preparedness

The predisposition to be afraid of certain things that can cause harm, influencing the development of anxiety disorders.

Flooding (exposure therapy)

A treatment method where the client is exposed to a feared object in a dramatic burst to reduce anxiety.

Avoidance Behavior

Behavior where an individual avoids situations or objects they fear, which maintains anxiety.

Neurotransmitter Dysfunction

Imbalance or abnormality of neurotransmitters in the brain that can contribute to anxiety disorders.

Negative Reinforcement

A process where avoidance leads to a temporary reduction in anxiety, reinforcing avoidance behaviors.

Obsessions

Intrusive, irrational thoughts that cause significant anxiety; often associated with OCD.

Compulsions

Intentional behaviors performed in response to obsessions in an effort to reduce anxiety.

PSYCHODYNAMIC PERSPECTIVES anxiety disorder

Fixation: 

●Unresolved conflict during psychosexual developments

●E.g., fixation at anal stage (2-3 years old) ➜ obsessive cleaning at later developmental stage

• Anxiety disorders are viewed as rooted in underlying psychodynamic conflict coming into consciousness.

• Freud’s idea: fixation or unresolved conflict during psychosexual development contributes to later symptoms.

• Example from transcript: fixation at the anal stage can lead to obsessive cleaning behaviors later in life.

• Implication: uncovering unconscious conflicts and past developmental tensions may be relevant for understanding or treating anxiety.

 

 

Psychodynamic theories distinguish between three board classes of psychopathology that for a continuum of functioning

Neurosis:

• Problems and living such as phobia is constant self-doubt and repetitive interpersonal problems such as trouble with authority figures

• Neurotic problem securing most if not all people at different points in their life and usually do not stop them from functioning reasonably well

 

Personality disorder

• Characterised by enduring maladaptive patterns of thought, feeling and behaviour that lead to chronic disturbances into personal occupational functioning

• Often Have difficulty maintaining meaningful relationships and employment, interpret interpersonal events is highly distorted ways and maybe chronically vulnerable to depression and anxiety

 

Psychosis

• Gross disturbances involving loss of touch with reality

• May hear voices telling them to kill himself or belief that the Secret Service is trying to assassinate them

• May occur in severe disturbed individuals and psychotic states can cure periodically

 

How to asses psychopathology ?

psychodynamic psychologist gather information to our patients current level functioning in life stress, the origins and course of the symptoms and events in person developmental histories

• All this information makes psychodynamic formula = A set of hypothesis about the patient’s personality structure meaning of the symptoms

• This formula attempts to answer three questions;

  1. What does the patient wish for and fear?

  2. What psychological resources does the person have at their disposal?

  3. How do they experience themselves and others?

 

• First questions focuses on persons dominant motive and conflicts

• Psychodynamic views neurotic symptoms as expression of or compromise among various motives

• Symptoms reflect unconscious conflict among wishes and fierce and efforts to resolve them

• Symptoms may also result from beliefs often in childhood which lead to conflict and defences

 

Second question is about ego function

• The person’s ability to function autonomously, makes sound decisions, I think clearly and regulate impulses and emotions

• So I could dynamic once to assess whether charlie’s ability to function and adapt to the environment Is impaired in other ways or whether his search for a beer is relatively isolated symptom

• For example, is He generally fearful or inhibited?

• Does He turn to dysfunctional behaviour such as drinking to alleviate his anxiety?

• Is he able to reflect his fierce and recognise them irrational?

 

Third question addresses object relations

• That is personal sensibility to form meaningful relationships with others and to maintain self-esteem

• Is charlie’s interpersonal problems specific to groups or are they part of a more serious underlying difficulty forming and maintaining relationships?

BEHAVIOURAL PERSPECTIVES 

Anxiety disorders are primarily due to environmental factors

 

●likely to manifest via conditioning

 

●First, acquisition of fear occurs through classical conditioning

 

●Learning to associate objects with fear

 Example: painful food poisoning with a brand of chicken leads to disgust/nausea upon smell of that chicken.

●Observational learning – vicarious learning through other’s reactions

How are fears maintained? Behavioral

●Operant conditioning – mostly through negative reinforcement (which is about avoidance to escape the trigger)

 

• Avoidance reduces fear temporarily, reinforcing the avoidance behavior.

• Example: a dog bite leads a child to avoid environments with dogs, possibly crossing the road when a dog is walked.

• Link to avoidance as a core maintenance mechanism in anxiety disorders.

 

• Conditioned emotional response (classical conditioning )

• The more he avoids the phobic situation the more his avoidance behaviour is negatively reinforced

• In other words, avoidance reduces anxiety which reinforces avoidance (operating condition)

 

 

Cognitive-behavioural clinicians

 

integrate an understanding of classical and operant conditioning with a cognitive-social perspective.

 

From a behavioural perspective, many psychological problems involve conditioned emotional responses, in which a previously neutral stimulus has become associated with unpleasant emotions.

Irrational fears in turn elicit avoidance, which perpetuates them and may lead to secondary problems, such as poor social skills.

 

 From a cognitive perspective, many psychological problems reflect dysfunctional attitudes, beliefs and other cognitive processes, such as a tendency to interpret events negatively.

 

COGNITIVE PERSPECTIVES 

• Cognitive factors contribute to anxiety by altering threat appraisal and information processing.

●Overestimate the likelihood or nature of a threat

●Perceive ambiguous situations as threatening

 ●Focus excessive attention on perceived threats 

Examples:

• People may choose stairs over a lift because they overestimate harm from potential lift failure.

• Waiting for exam results induces anxiety due to uncertainty and self-doubt.

●Inability to appraise and cope with perceived threat > more likely to develop anxiety disorders

●Negative selective memory

 

●Vicious cycle of anxiety 

Stressful event ➜ negative reinforcement (avoidance) ➜ relief ➜ negative belief about event

 

●Vicious cycle of anxiety 

Stressful event ➜ negative reinforcement (avoidance) ➜ relief ➜ negative belief about event

 

Vicious circle of anxiety (cognitive–emotional–physiological loop):

• cognition leads to physical symptoms (e.g., increased heart rate, tummy upset), which then reinforce fear and avoidance.

• Example: (Technology submission scenario)

  • Scenario: a technical issue when submitting an assignment leads to negative beliefs about using technology, physical symptoms (rapid heart rate, tummy upset), and avoidance behaviors (asking someone else to submit).

  • Consequence: avoidance reduces fear temporarily but reinforces the belief that technology cannot be trusted, maintaining anxiety.

  • Therapeutic implication: Cognitive Behavioral Therapy (CBT) can help manage thoughts and behaviors related to anxiety and obsessive-compulsive disorders by restructuring cognitions and reducing avoidance.

 

Biological approach

 biological approach looks for the roots of mental disorders in the brain's circuitry, such as neurotransmitter dysfunction, abnormalities of specific brain structures or dysfunction anywhere along a pathway that regulates behaviour or mental processes. Theorists of various persuasions often adopt a diathesis-stress model, which proposes that people with an underlying vulnerability (called a diathesis) may exhibit symptoms under stressful circumstances.

 

• biological approach looks for roots of mental disorders and brain circuits

• For example anxiety curious the activation of neural circuits involving the amygaula and frontal lobes

• Also focuses on heritability of psychopathology

• Carefully assess family history of disorders

 

 

•  Aside from genetics, biological researchers have searched for the roots of psychopathology, primarily two areas

1. They examine specific regions of the brain that differ between people with a particular disorder and those without it

2. Researchers have looked for evidence of neurotransmitter dysfunctioning in particular disorders on the assumption that too much or too little neurotransmitter activity could disrupt normal balance of neural firing

• For example, normal anxiety reactions involve neurotransmitter  norepineepherine  and whose receptors are overly sensitive in circuits involving the amygdala are likely to experience psychological anxiety

 

diathesis

proposes that people with an underlying vulnerability (called a diathesis) may exhibit symptoms under stressful circumstances.

Diatheis- stress model

• prepare that people with an underlying vulnerability(called a diathesis) may exhibit symptoms under stressful circumstances

• Diathesis may biological such as genetic predisposition for anxiety core by over activity of Nurofen or

• Environmental, stemming from events such as history of neglect, excessive parental criticism or uncontrolled painful events in childhood

System approach

A systems approach explains an individual's behaviour in the context of a social group, such as a couple, family or larger group.

Most systems clinicians adopt a family systems model, which views an individual's symptoms as symptoms of family dysfunction.

The methods family members use to preserve equilibrium in a family are called family homoeostatic mechanisms.

Family systems theorists focus on the ways families are organised, including family roles the parts individuals play in thefamily), boundaries (physical and psychological limits of the family and its subsystems) and alliances (patterns in which family members side with one another).

They also focus on problematic communication patterns.

PTSD aetiology

Predisposition to PTSD:

●Personality

●Coping styles

●Intellectual functioning

●Best predictor is the use of avoidant strategies

• i.e., efforts to avoid thinking about painful events 

●Highlights suppression of emotions as keeping people with PTSD at high states of vigilance

 

• High-risk groups: military personnel and first responders are at heightened cumulative risk due to exposure to traumatic/violent events.

• Gulf War veterans study (one-year assessment):

  • Best predictor of PTSD was the use of avoidant coping styles (efforts to avoid thoughts about the traumatic event).

• Emotional processing and arousal patterns:

  • Individuals with PTSD are likely to suppress emotions, which maintains high states of implicit activation.

  • Implicit activation keeps individuals alert to trauma-related events and can contribute to intrusive memories

  • Sometimes there are breakthroughs or intrusive recollections; the underlying pattern is persistent hypervigilance to threat.